This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Patients with chronic renal disease occupy the highest risk stratum for subsequent arteriosclerotic cardiovascular disease (CVD) events. The excess risk of CVD in chronic renal disease is due in part to a higher prevalence of established arteriosclerotic risk factors, including older age, high blood pressure, diabetes, high cholesterol and triglycerides and physical inactivity. Prominent among these risk factors are elevated levels of atherothrombotic homocysteine. This multicenter, randomized, double blind controlled clinical trial is designed to determine whether total homocysteine lowering treatment with a standard multivitamin augmented by a high dose combination of folic acid, vitamin B12, and vitamin B6, versus treatment with an identical multivitamin containing no folic acid, and Estimated Average Requirement (EAR) amounts of vitamin B6 and B12, reduces the pooled rate of recurrent and de novo cardiovascular disease outcomes, among clinically stable renal transplant recipients who have mild to moderate elevated total homocysteine levels